自体骨髓干细胞移植治疗失代偿期乙型肝炎肝硬化临床观察  

Clinical efficacy of autologous bone marrow stem cell transplantation in treatment of hepatitis B patients with decom pensated liver cirrhosis

作　　者：陈阳述[1] 欧阳石[1] 程涛[1] 刘树人[1] 李灼亮[1] 孔祥平[1] 周赤龙[1] 

机构地区：[1]解放军第458医院全军肝病中心,广州市510602

出　　处：《实用肝脏病杂志》2013年第2期116-118,共3页Journal of Practical Hepatology

基　　金：总后勤部卫生部科研专项(08BJZ07)

摘　　要：目的观察自体骨髓干细胞移植治疗失代偿期乙型肝炎肝硬化患者的临床疗效及安全性。方法 67例失代偿期乙型肝炎肝硬化患者被分为自体骨髓干细胞移植组33例和基础治疗对照组34例。对照组采用常规口服核苷类似物抗病毒和对症支持治疗,细胞移植组在基础治疗的同时无菌抽取自体骨髓65～95ml,分离纯化自体骨髓单个核细胞,培养、扩增至3.0×106～5.0×106个,然后经肝动脉导管注入肝脏。分别在治疗前,治疗后4周、12周和24周观察疗效。结果在治疗后第4周,治疗组和对照组ALT分别为49.8±31.3U/L和64.4±39.7U/L(P<0.05),PTA为38.48%±7.2%和37.48%±6.9%(P>0.05),CHE为2025±127U/L和2012±321U/L(P>0.05);在治疗后第12周,治疗组和对照组ALT分别为41.8±17.9U/L和43.6±21.8U/L(P>0.05),TBIL为23.2±9.5μmol/L和27.5±13.2μmol/L(P<0.05),ALB为27.3±6.7g/L和26.8±6.8g/L,PTA为44.3%±9.4%和37.5%±6.9%(P<0.05),CHE为3018±243U/L和2098±431U/L(P<0.05);在治疗后第24周,治疗组和对照组ALT分别为32.2±12.1U/L和35.6±18.2U/L,TBIL为20.9±8.8μmol/L和24.9±10.7μmol/L(P<0.05),ALB为29.2±6.3g/L和28.9±7.5g/L,PTA为48.2%±6.7%和46.2%±7.8%,CHE为5012±213U/L和4089±278U/L(P<0.05);在治疗4周时,治疗组患者Child-Pugh计分和MELD评分分别为9.8±2.3和28.8±10.3,显著低于对照组(10.3±3.4和29.8±10.3,P<0.05);在治疗12周,治疗组患者Child-Pugh计分和MELD评分分别为8.8±3.5和25.6±10.0,显著低于对照组(9.0±4.5和27.5±13.2,P<0.05);在治疗24周,治疗组患者Child-Pugh计分和MELD评分分别为7.9±4.5和24.0±8.9,显著低于对照组(8.2±3.6和27.0±10.7,P<0.05)。结论在综合治疗的基础上联合自体骨髓干细胞移植治疗失代偿期肝硬化,能更有效地改善肝功能,手术相对安全,风险较低。Objoctive To evaluate the clinical efficacy and safety of intrahepatic transplantation of autologous bone marrow stem cell （BMSC）in treatment of hepatitis B patients with decompensated liver cirrhosis. Methods 67 hospitalized hepatitis B patients with decompensated liver cirrhosis in our department were randomly divided into two groups. There were 33 patients in the transplantation group,and 34 patients in the control group. 65-95ml of bone marrow were obtained from patients in transplantation group,and BMSCs were purified and cultured in vitro and 3.0×10^6-5.0×10^6 cells were harvested into lOml cell suspension,then the cells were injected into the liver through the hepatic artery. The laboratory parameters, clinical symptoms and adverse reactions were observed re- spectively at week 4,12 and 24 after transplantation. Results At 12th week after transplantation,serum ALT levels in transplantation and control groups were 41.8±17.9U/L and 43.6±21.8U/L （PM）.05）,respectively,total bilirubin were 23.2±9.5μmol/L and 27.5±13.2μmol/L （P〈0.05）,ALB were 27.3±6.7g/L and 26.8±6.8g/L,PTA were 44.3%±9.4% and 37.5%±6.9%（P〈0.05）,CHE were 3018±243U/L and 2098±431U/L （P〈0.05）;at 24th week,serum ALT levels in the two group were 2.2±-12.1U/L and 35.6±18.2U/L,TBIL were 20.9±8.8μmol/L and 24.9±10.7μmol/L （P〈0.05）,ALB were 29.2±6.3g/L and 28.9±7.5g/L,PTA were 48.2%±,6.7% and 46.2%±7.8%,CHE were 5012±213U/L and 4089±278U/L （P〈 0.05）;at 24th week, the Child-Pugh and MELD scores in the transplantation group were 7.9±4.5 and 24.0±8.9, respectively,much lower than in control （8.2±3.6 and 27.0±10.7,P〈0.05）. Conclusion The autologous bone marrow stem cell transplantation in hepatitis B patients with deeomoensated liver cirrhosis is effective and safe.

关 键 词：乙型肝炎 肝硬化 自体骨髓干细胞 移植 

分 类 号：R575.2[医药卫生—消化系统]